Recreational Injury Interventions



Handball is one of the most popular sports in Denmark, with approximately 137,000 players registered in the Danish European Team Handball Association. Up to 50 injuries per 1,000 game hours have been reported in European handball, Wedderkopp et al, 1999. It is a sport in which injuries are common and most frequent in the lower extremities. Additionally, it has been reported that more than 50% of traumatic handball injuries occur in the lower extremities, Wedderkopp et al, 1999. Poor postural control, which can be improved through balance and propriocpeitve training, is believed to significantly contribute to the incidence of lower extremity injuries. Ankle disk or balance training has been reported to have a positive effect on balance and proprioception in athletes who have had injuries to their knee or ankle, Wedderkopp et al, 1999.

The study reviewed below evaluates the effectiveness of a balance training and warm-up intervention program in reducing the number of traumatic injuries to the lower extremities in young female handball players who have not necessarily endured a previous injury.

Review of handball studies:


Wedderkopp, 1999

Study design and target population

Randomized controlled trial.

Population: Female European handball players. 11 teams (111 players) in intervention group, 11 teams (126 players) in control group.

Age 16-18 years.


Training program consisting of 10-15 min. ankle disk session at all practices and 2 or more functional activites to warm-up all muscle groups in the upper and lower extremities for 10 months, (Aug 1995 - Ma y 1996).


Injury incidence for all injuries, injury incidence for lower extremity injuries, injury severity, position specific injury incidence.


Control group 5.9 times higher risk of acquring an injury than players in the intervention group.

There were significantly more ankle and finger sprains in the control group than the intervention group. 23 ankle (P<0.01) and 9 finger sprains (P<0.05) in control group, compared to 6 ankle (P<0.01) ankle and 1 finger sprain (P<0.05) in the intervention group.

Significant difference with respect to injury incidence and playing position between intervention and control groups (P<0.01). For intervention group 6 defense, 6 offense, 1 midfield, 1 during warm-up. Compared to 13 defense, 40 offense, 5 midfield, 8 during warm-up for the control group.

Practice time and not using the prevention program were the only significant risk factors (P<0.05). Odds-ratio for players in prevention program and practicing 6 hrs/week was the lowest 0.21 (95% CI 0.01-4.87) compared to those practicing 2 hours/week 0.60 (95% CI 0.21-1.69).

Practice time was directly proportional to odds-ratio for control group, with the highest ratio being 8.04 (95% CI 1.61-40.11) for those who practiced 7.5 hrs/week and 2.30 (95% CI 1.21-4.34) for those praciting 3 hrs/week.

Study quality and conclusions

Intervention program appeared to decrease the number of both traumatic and overuse injuries significantly.

Significantly lower number of injuries in the intervention group for only minor and moderate injuries.

Incidence of injury for control group may have been effected by increased injury awareness due to participation in the study.

Difficult to determine whether the balance training or the warm-up was the major factor in reducing injury rates.

Summary of handball studies

It may be possible to reduce the number of and incidence of lower extremity injuries in young female handball players through balance training and warm-up intervention. Young athletes, in particular, are at a very high risk of sustaining injuries, therefore there is a need for an effective intervention program.

Recommendations on handball

A prevention program that incorporates warm-up and balance training in all practices is recommended at this time. Additionally, injury awareness sessions may also prove to be beneficial injury prevention intervention.

Recommendations for future research

Future research should consider the effects of injury awareness and education on injury prevention, and examine the benefits of balance training and warm-up interventions independently. Furthermore, the impact of recurrent injuries should be considered.